Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings
V. Jordan Greenbaum, M.D., Michelle S. Livings, M.P.H., Betty S. Lai, Ph.D., Laurel Edinburgh, M.S.N., A.P.R.N., Peggy Baikie, D.N.P., R.N., Sophia R. Grant, M.D., Jamie Kondis, M.D., Hillary W. Petska, M.D., M.P.H., Mary Jo Bowman, M.D., Lori Legano, M.D., OriakuKas-Osoka, M.D. and Shannon Self-Brown, Ph.D
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Abstract
Purpose: Estimate the prevalence of child sex trafficking (CST) among patients seeking care in multiple health care settings; evaluate a short screening tool to identify victims in a health care setting.
Methods: This cross-sectional observational study involved patients from 16 sites throughout the U.S.: five pediatric emergency departments, six child advocacy centers, and five teen clinics. Participants included English-speaking youth ages 11-17 years. For emergency department sites, inclusion criteria included a chief complaint of sexual violence. Data on several domains were gathered through self-report questionnaires and examiner interview. Main outcomes included prevalence of CST among eligible youth; sensitivity, specificity, positive/negative predictive values, and positive/negative likelihood ratios for a CST screening tool.
Results: Eight hundred and ten participants included 91 (11.52%) youth from emergency departments, 395 (48.8%) from child advocacy centers, and 324 (40.0%) from teen clinics. Overall prevalence of CST was 11.1%: 13.2% among emergency department patients, 6.3% among child advocacy center patients, and 16.4% among teen clinic patients, respectively. The screen had a sensitivity, specificity, and positive likelihood ratio of 84.44% (75.28,91.23), 57.50% (53.80,61.11), and1.99% (1.76,2.25), respectively.
Conclusions: This study demonstrates a significant rate of CST among patients presenting to emergency departments (for sexual violence complaints), child advocacy centers, and teen clinics. A six-item screen showed relatively good sensitivity and moderate specificity. Negative predictive value was high.
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